Q: My child is afraid of the epinephrine auto-injector. What can I do?
Dr. Pistiner: I’ve met kids whose eyes widen and tears well up at the mere mention of an auto-injector. This is a very real issue that comes up for some children.
We should all keep in mind that sometimes the unknown can be scarier than reality. We see this at night with “monsters” hiding under the bed, in the closet or somewhere lurking in the dark. Kids sometimes fill in the gaps with their own scarier answers.
Being afraid of your own auto-injector can make for a challenging situation. We want our children to be open and honest with us when they feel symptoms of a food allergy and want them to see their emergency medicine as something positive and helpful, not as painful or scary.
Here are some examples of ways that I have approached these situations with my own patients.
Ask About Child’s Fear
A good place to start is to ask children what it is about the auto-injector that makes them feel afraid. For some it is it the needle itself. If you ask these children to show you with their fingers how long they think the needle is, their answer may surprise you. I’ve met many kids who think the needle is the length of the entire device. If this were true, this would be terrifying, even for adults. Fortunately, this is far from the case.
Correcting this misperception can be a huge help with the fear problem. The reality is that auto-injector needles are shorter than the width of a dime, while the rest of it is what holds the medicine and mechanism inside. I’ve seen the relief on children’s faces when I hold out a dime to demonstrate actual length.
Discuss Minor Side Effects
Other kids, usually older ones, worry that epinephrine itself might hurt them or be dangerous. This is where reviewing how epinephrine may make someone feel can go a long way. Some of the common and expected side effects are pale skin, faster heartbeat, and shakiness, less common may be some headache or feeling sick in your stomach. These effects can help us to know that the medicine is working. Anaphylaxis must always be treated with epinephrine.
Feel Better Factor
It’s also most helpful to let kids know that if you have an allergic reaction that requires epinephrine, the shot is going to make you feel a whole lot better really quickly. Our auto-injectors help us to get the medicine where it needs to go in our bodies – and fast. This is why we give it in our thigh muscle, and this is why there is a short and skinny needle.
As with anything new that you learn about managing food allergies, discuss with your health-care provider before making any changes in management. Also, if your child is worried about their auto-injector or food allergies in general, let your health-care team know and seek additional support if the concern remains or limits their activities.
For more information on empowering kids, see:
Three Food Allergy Teaching Points: Let’s Empower Kids
Parenting Coach: Coping After Anaphylaxis
Ask the Allergist: Encouraging a Child to Eat after Anaphylaxis
Dr. Michael Pistiner is an allergist in Massachusetts and clinical instructor at Children’s Hospital Boston, Harvard Medical School. He offers allergy teaching tools at Allergyhome.org.
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